Factors associated with prolonged ‘decision-to-delivery intervals’ during emergency caesarean deliveries in Ethiopia: systematic review with meta-analysis, 2024

Emergency cesarean deliveries should follow the internationally recognized standard of ≤ 30 min between the decision and delivery of the fetus, even though this is impractical in Ethiopia. There is a correlation between higher rates of perinatal morbidity and mortality and longer times between decision-making and delivery of the fetus/s. In Ethiopia, there is no pooled national representative prevalence of the prolonged decision-to-delivery time interval. This systematic review with meta-analysis, which is based on the most recent data, presents the factors affecting the extended decision -to-delivery time interval and the pooled prevalence of it in emergency Caesarean deliveries. This systematic review and meta-analysis was conducted using the Preferred Reporting Items 2020 checklist. We search through the electronic databases PubMed/Medline, Scopus, Web of Science, Hinari, and Google Scholar. We included the six articles based on the reported decision-to-delivery time interval as inclusion criteria. The pooled prevalence of extended decision-to-delivery intervals and the factors associated with them were calculated using a random-effects model. We used Egger’s and funnel plots to further evaluate the publication bias. All statistical analyses were conducted using STATA software, version 17.0. The results of this meta-analysis and systematic review showed that the pooled prevalence of prolonged decision-to-delivery intervals (> 30 min) was 79.20% [95% CI = 73.46, 84.93]. Time spent gathering supplies and equipment necessary to emergency caesarean delivery (6.68, 95% CI = 3.92, 11.36), the day of the decision to have a caesarean delivery (working day, weekend or night time) (4.28, 95% CI = 1.17, 15.66), and the type of anesthesia (spinal or general) (3.53, 95% CI = 2.43, 5.13) were statistically significantly associated with prolonged decision-to-delivery time intervals. Childbirth was not finished within the recommended time intervals (≤ 30 min) in most emergency cesarean deliveries in Ethiopia. Therefore, In order to address institutional delays in emergency cesarean deliveries, Obstetrics care providers and health facilities should be better prepared and ready for rapid emergency action. Additionally, it is important to discourage unreasonable gaps between decision-making and the child’s birth.